Baltimore - A four-month Scripps Howard News Service review found that for every high school that has one or more athletic trainers regularly assigned to the training room, two other schools rely on a patchwork of coaches trained in first aid and part-time athletic trainers, nurses, emergency medical technicians or team doctors.
As Beth Mallon of San Diego knows, this distinction could mean life or death. Mallon's son, Tommy, broke his neck in a collision during his final high-school lacrosse game as a senior at Santa Fe Christian in May 2009.
He wanted to get up off the field. But athletic trainer Riki Kirchoff wouldn't let him move and called for a backboard. "That saved his life," said Mallon, whose family has set up an advocacy group for injured athletes. "It maintained the integrity of the fracture and it didn't kill him or paralyze him. There couldn't be better testimony for having athletic trainers in all high schools."
Nine months earlier, in Louisville, Ky., there was no athletic trainer at Pleasure Ridge Park High School when 15-year-old Max Gilpin collapsed, suffering from apparent heat stroke, as the team ran sprints at the end of football practice. He died three days later.
The coaches who cared for Gilpin had little training in heat illness and didn't use a whirlpool and ice available in the locker room to cool him.
Kentucky athletic officials have since moved to require additional online sports-medicine training for all high-school coaches, but as in 49 other states, there is no mandate that an athletic trainer be available at high schools.
Distinct from personal trainers or fitness instructors, certified athletic trainers must have at least a bachelor’s degree from an accredited university to practice and receive specialized training in the prevention, diagnosis, treatment and rehabilitation of sports-related injury and illness among people of any age.
There are only about 6,400 athletic trainers working in secondary schools across the United States, according to the National Athletic Trainers’ Association (NATA), compared with some 18,400 public and private high schools sponsoring interscholastic sports, according to a review of state high school athletic association rolls by Scripps.
High-school athletic trainers are more likely to be full time at larger, suburban schools, and are less common in smaller, rural schools and inner-city schools, according to statistics provided by NATA, which represents about 85 percent of the profession nationwide.
"The bigger schools in our state and probably most states have pretty good access, but we did a survey a couple years ago that found only about 10 percent of our smallest 1A and 2A schools had an athletic trainer full time," said Mike Carroll, athletic trainer for Stephenville High School in Stephenville, Texas.
Organizations as disparate as the American Medical Association and the North American Booster Club Association endorse having a certified trainer in high schools, but many administrators feel they can't afford one.
Athletic trainers on school staff typically make about the same salaries as teachers -- many do have classroom assignments -- but usually receive a bonus for extra hours. The average salary nationally is about $42,400. About a third of high-school athletic trainers work for clinics that contract with schools for their services, full or part time.
Most of the nearly 2 million injuries among U.S. high-school athletes each year are not life threatening, but half are serious enough to require medical attention and at least one day off the field. Having someone trained to know what requires ice and tape or a 911 call can make all the difference.
Scripps analyzed the most recent five years of data on injuries from sports typically played in high school among 14- to 18-year-olds reported by a national network of emergency rooms to the U.S. Consumer Product Safety Commission.
Among the findings:
- Where there were more athletic trainers, a higher percentage of teens with serious injuries like concussions, fractures and internal injuries were sent to emergency rooms;
- Although less than 3 percent of all the sports injuries presented at emergency rooms required hospital admission, there were slightly higher rates of admissions of those injuries in states with more athletic trainers;
- In states with fewer athletic trainers, a greater share of injuries generally viewed as minor -- contusions, abrasions and dislocations -- were likely to be sent to the ER than in states with more of the professionals.
"It's true that schools with trainers are more likely to send serious injuries along to a higher level of care," said Fred Mueller, director of the National Center for Catastrophic Sport Injury Research at the University of North Carolina, Chapel Hill. "Compared with first-aid-trained coaches or EMT, an athletic trainer is more apt to look at an injury, define it, treat what they can locally."
Tamara C. Valovich McLeod,